Nurse practitioner (NP)
Assess patients; order and interpret diagnostic tests; diagnose and treat illness; prescribe medications, in
some states with doctor supervision.
RN plus master's or doctoral degree
and advanced clinical training. National certification test and state license.
Certified nurse midwife (CNM), certified midwife (CM)
Deliver prenatal, delivery,
and postpartum care, family-planning services, and gynecological care; prescribe medications.
Nursing or bachelor's degree plus completion of an accredited graduate nurse-midwifery course. National certification test and state license.
Physician assistant (PA)
Examine patients, diagnose and treat illness, order and interpret lab tests, perform procedures, assist in surgery, provide patient education and counseling, make rounds in hospitals and nursing homes, prescribe medications.
Bachelor's degree, followed by completion of an accredited P.A. program modeled on the medical-school curriculum (average length of program is 27 months, and
most grant master's degrees). National certification test and state license.
Podiatrist (DPM), also known as podiatric physician or podiatric surgeon
Diagnose and treat conditions of the foot, ankle, and related structures of the leg; prescribe medications. May specialize
in surgery, sports medicine, wound care, pediatrics, or diabetic care.
Four years of podiatric medical school plus three years of hospital residency training. With advanced training and experience, can obtain board certification from the American Board of Podiatric Medicine or the American Board of Podiatric Surgery. State license.
Clinical psychologist (Ph.D., Psy.D.), licensed clinical social worker, licensed professional counselor (LPC)
Diagnose and treat mental illness and emotional and behavioral problems in individuals, couples, groups, and families.
Ph.D. and Psy.D.: doctoral degree.
Licensed clinical social worker and LPC: master's or doctoral degree plus two or more years of supervised post-graduate experience. State licenses. Counselors
can also be certified by National Board
of Certified Counselors.
Food and nutrition counseling for general health, nutritional deficiencies, or disease management.
Bachelor's degree with courses approved by professional organization, plus completion of an internship. National examination.
Dispense medication and immunizations, check for potential drug interactions, provide counseling on how
to take medication and limit side effects.
Doctor of pharmacy degree from an accredited school, plus internship. Two licensing exams, one covering pharmacy skills and knowledge and the other covering pharmacy law.
M.D. (medical doctor)
Diagnose and treat illness
and injury, including surgery, examinations, testing, and prescribing medication.
Four years of medical school plus up to six years of residency training. Optional clinical fellowships and specialty certification. National licensing exams. State license.
DO (doctor of osteopathic medicine)
Practice as medical doctors
do in any specialty area. Some osteopaths also perform musculoskeletal manipulation.
Four years of osteopathic medical school, followed by medical or osteopathic residency training. Optional specialty certification. National licensing exam. State license.
Registered nurse (RN)
Provide patient care and education, care coordination, physical exams, and health histories.
Diploma or associate or bachelor's
degree from an approved nursing program. National licensing exam.
Licensed practical nurse (LPN), licensed vocational nurse (LVN)
Provide basic nursing care under the direction of registered nurses and doctors.
Completion of a state-approved educational program (usually one year) and passage of a licensing exam.
Rom Hendler is CEO & cofounder of Trustifi, a provider of SaaS-based security and email encryption.
Artificial intelligence (AI) and machine learning (ML) continue to gain headlines and impact the high-tech landscape at the boardroom level. Yet this technology is also rapidly becoming a destructive force causing considerable security risks in the highly regulated healthcare space.
Nefarious cyberattacks, including synthetic fraud and phishing attempts, continue to increase in scale and effectiveness thanks to AI-based tools now available to hackers. A synthetic fraud attack uses portions of a victim’s identity garnered from the internet to compile a false but convincing profile with which to commit fraud. This includes crimes like applying for patient financing under false pretenses, requesting medical services, or submitting fraudulent insurance claims.
This article highlights the rapid advancement of AI-assisted synthetic fraud attacks and medical identity theft as they affect healthcare providers and patients, along with updated recommendations for patient data privacy, AI-powered email security solutions, and data protection policies.
AI bots have long been a hacker favorite for collecting stolen credentials, accelerated by the rise of natural language generators like ChatGPT. Bots mine the internet for accurate information on a victim’s identity and use that in crafting their attacks, making it challenging for the victim to recognize these attempts as fraudulent. These emails typically include a link to a convincing imposter website that tricks recipients into providing usernames and passwords. When these breaches occur, identity theft can also result in reputational damage for the healthcare provider.
In the past, phishing attacks were easy to detect because of spelling mistakes and vague information requests. Present-day attacks incorporate persuasive personal details such as the user’s bank or healthcare provider’s name, and references to the user’s home city or local pharmacy. This is known as “geo-phishing.”
In the case of synthetic fraud that compiles information from different victims, it’s harder to determine that the resulting profile is fake since much of the data used to assemble it belongs to genuine individuals. The cybercriminal uses the synthetic profile to apply for patient financing or otherwise scam large amounts of money and services. Material used to create synthetic fraud profiles is often acquired through compromised email data.
In addition, hackers can now leverage AI-based technology to rapidly create near-perfect scripts for phishing schemes using ChatGPT. Hackers will use the patient’s public email address and password from a successful phishing attack to log in to a medical provider/patient portal with these stolen credentials. If two-factor protection is not enabled on the EMR portal, the hacker can access patient records and correspondences with practitioners.
Once hackers can access a practitioner, they can request medication refills and submit false insurance claims to the provider or Medicare carriers. All this shows how critical it is for healthcare organizations to secure their patient data and infrastructures with the most up-to-date cybersecurity solutions, including AI-based tools to combat these very sophisticated (and similarly AI-powered) attacks. Traditional, legacy security capabilities in firewalls, secure email gateway applications, and first-generation multifactor authentication often fail to stop the advanced AI-powered threats hackers continue to develop.
Hackers can alter their attack methods, extend their attacks across several countries in mere seconds, and shut down their operations globally to avoid detection. Most healthcare providers’ current security adaptive controls still rely on reporting events into a Syslog file or an early generation security information and event management (SIEM) tool lacking AI capabilities. And too many solutions simply utilize blacklisting of known malicious IP addresses, which don’t detect sophisticated, contextually based threats.
So what strategies can healthcare organizations put into action to guard against increased AI-driven attacks? These guidelines can help companies remain HIPAA compliant and protect their patients against victimization.
• Abandon outdated technology and strategies: Medical providers can increase their protection by phasing out antiquated, legacy techniques. A surprising amount of healthcare organizations still use fax technology to transmit sensitive information. Companies are far better off implementing a modern protocol such as AES 256-bit encryption for the transfer of sensitive material like patient records. In addition, outdated operating systems like Windows XP (still in too many office environments) are often no longer supported by security updates and create vulnerabilities.
• Use AI to combat AI: The bright side of artificial intelligence is it can deliver as many effective capabilities to cybersecurity solutions as it does to criminals. Software should leverage sophisticated AI-based tools, including optical character recognition and algorithms that recognize “red flag” keywords that could indicate a breach.
• Deploy automation: Administrators can automate HIPAA compliance. Effective solutions allow admins to set their systems to automatically encrypt or flag sensitive email messages that fall under HIPAA statutes. This takes the burden of deciding what material needs to be encrypted out of the hands of employees, reducing human error.
• Implement security awareness policies: Since a majority of breaches start with a phishing attempt, make sure your staff is aware of the latest schemes and imposter email strategies. Create policies around vulnerable activities (e.g., establish a protocol where requests for wire transfers or financial login credentials are confirmed verbally).
• Focus on ease of use: Your security should be simple for employees to use. If measures are convoluted and laborious, users will abandon them, and your security investments will go by the wayside.
Preventing synthetic fraud and medical identity theft does not start with merely detecting threat vectors. Prevention begins by protecting patient information and network email data with advanced cybersecurity solutions powered by AI technology, which will help deter imposter attacks and compromised credentials, and will identity theft from the outset. It’s essential to deprive hackers and fraudsters of the key components that facilitate their attacks by protecting user attributes such as login information, Social Security numbers, and passwords, especially via email data.
Email security platforms continue to deliver integrated features, including mature AI-enabled engines that enable threat detection, email encryption, and data loss prevention. Organizations that want to enhance their email security while reducing complexity should continue to research these solutions, employing AI-driven, easy-to-use, next-generation technologies as strategies to combat the forthcoming level of AI-powered attacks.
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It's not just you. Energy levels drop for all of us while we're in the heat of summer. There's more to be concerned about than just a sunburn; the heat has a real impact on your body. Let's dig into why it affects us and examine five easy strategies that'll go a long way toward boosting your energy.
For more, see how to exercise safely in the heat and check out these fool-proof hacks to sleep cool at night.
When it's hot, the body has to work harder to maintain homeostasis (a balance between all your body's systems to keep things functioning properly). So even if you aren't getting physical, just being in the heat is enough to tire you out, because your body is working overtime to keep you cool. Your heart rate rises, and your body burns calories at a higher rate.
The body's thermoregulatory methods present in two ways. Vasodilation, or the widening of the blood vessels, lets more blood get to the surface of your body, which helps regulate internal temperature. Sweating is the other bodily response to being hot -- your system moves core body fluid to the outside. These processes require energy and effort.
These simple strategies can help you fight off fatigue and enjoy the warmer weather.
According to the National Library of Medicine, up to 28% of older adults in the US have suffered from dehydration. Dehydration is more than just being thirsty. The body needs water to function. There's a danger of being dehydrated in the heat, because your body can't cool you off, leading to heatstroke. The more you sweat, the more you deplete your fluid reservoir.
Dehydration symptoms can be subtle, especially if you're chronically dehydrated and get used to the dry lips, tiredness and headache associated with dehydration.
Staying hydrated is one of the essential ways to beat fatigue in the heat. You have to replace the water you sweat out. When you know you'll be outside, it's a good idea to increase your water intake to prepare your body for what it'll lose through sweat.
Water is the best liquid source to combat dehydration. However, sports drinks can replace the salt lost in sweat, making them another good option. Avoid drinking alcohol while in the heat, as it's a diuretic that worsens dehydration.
Moderating your time in the sun helps you beat fatigue in two ways. First, sitting in the shade or going inside can keep your body from overheating, which saves energy. Secondly, it protects your skin from UV rays. Sun damage to the skin can also contribute to fatigue because your body expends energy to repair the skin.
You should always wear sunscreen when outside. The American Academy of Dermatology recommends using SPF 30 or higher and reapplying every two hours. Even if you apply sunscreen, sitting under umbrellas and wearing loose clothes and hats that block the sun is recommended.
Read more: Best Sunscreen to Protect Your Skin This Summer
B vitamins are essential nutrients that aid in bodily functions, like moving oxygen through the body and breaking down amino acids. They're also central to energy because they help in cell metabolism. B vitamins become even more important during the hot months, when your energy levels are drained quicker.
These B vitamins are central to energy: Thiamin, riboflavin, niacin, pantothenic acid, B6, folate and B12. Adding vitamin-rich foods to your diet is an easy way to naturally boost your energy. Great food sources of B vitamins include leafy greens, brussels sprouts, eggs, avocados and whole grains.
You can also add a multivitamin to supplement your diet and get all your B vitamins.
Snacks are your secret weapon in the heat. They can help you boost your energy and replace the electrolytes and salt your body is losing in the heat. I know what you're thinking: When it's hot, sometimes the last thing you want is to eat anything. It's best to keep your snack small and nutritious. Fruit and veggies are full of electrolytes, and nuts and trail mixes are great for replacing salt.
One of the most effective ways to combat fatigue during the warmer months is by doing multiple check-ins on your health throughout the day. Heat exhaustion and heatstroke can creep up on you. You can assess your needs and respond accordingly by listening to your body.
If you start feeling dizzy or lightheaded, get somewhere cool immediately and drink some water. Putting an ice cube on your wrists is also an effective way to cool down, since the blood vessels are closer to the surface of the wrist.
In most instances, being in the heat is just uncomfortable and leaves you feeling worn out. However, there are times when you may approach a heat-related illness -- heat exhaustion or heatstroke. The main difference between the two is how your nervous system reacts. According to the US Centers for Disease Control and Prevention, a person may become confused or have slurred speech during heatstroke.
Read more: Heatstroke Symptoms: What You Need to Know as Record Heat Waves Approach
Symptoms of heat exhaustion are generally the precursor to heatstroke. They include heavy sweating, cold and clammy skin, muscle cramps, nausea, dizziness or passing out. If you experience any of these symptoms, you must immediately try to cool off so you don't pass into heatstroke territory.
You should be able to enjoy your spring and summer months without feeling drained. And you can. All it takes is a few intentional practices to prepare your body.
For more from wellness, check out all the reasons that you're oversleeping and easy productivity hacks to get more done.
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Autism spectrum disorders
A quarter (24%) of autistic doctors have attempted suicide, and more than three-quarters (77%) have considered it, according to a new study by Brighton and Sussex Medical School (BSMS), Thomas Jefferson University and Autistic ...
Radiological imaging is a major and increasing source of radiation exposure worldwide. Computed tomography (CT) is the largest contributor to medical radiation dose patients receive. Typically, CT scans impart doses to organs that are 100 times higher than doses imparted by other lower dose modalities such as chest X-rays. In general, CT examinations may involve doses (typically an average of 8 mSv) which may be equal to the dose received by several hundreds of chest X-rays (about 0.02 mSv/chest X-ray).
During an IAEA consultation on justification in 2007, it was estimated that up to 50% of examinations may not be necessary. It should be anticipated that part of the increase in global annual mean dose that has been observed recently is due to unjustified radiological procedures. Direct epidemiological data suggest that medical exposure to low doses of radiation even as low as 10-50 mSv might be associated with a small risk of cancer induction in the long term. The fact that a considerable percentage of people may undergo repeated high dose examinations , such as CT (sometimes exceeding 10 mSv per examination) dictates that caution should be used when referring a patient for radiological procedures. Health professionals need to make sure the patient benefits from the procedure and risk is kept minimal.
However, ensuring maximum benefit to risk ratio for the patient is not a trivial task. Referring medical practitioners, in a large part of the world, lack training in radiation protection and in risk estimation. 97% of practitioners who participated in a study underestimated the dose the patient would receive from diagnostic procedures. The average mean dose was about 6 times higher than the physicians had estimated. The fundamental principles of radiation protection in medicine are justification and optimization of radiological protection. Referring medical practitioners have a major role in justification. They are responsible in terms of weighing the benefit versus the risk of a given radiological procedure.
Justification requires that the expected net benefit be positive. According to principles established by the International Commission on Radiological Protection (ICRP) and accepted by major international organizations, the principle of justification applies at three levels in the use of radiation in medicine.
Yes, jointly with the radiological practitioner. As stated above, justification at the third level is the responsibility of the referring medical practitioner, as is the awareness about appropriateness criteria for justification at level 2. According to the BSS, the radiological exposure has to be justified through consultation between the radiological medical practitioner and the referring medical practitioner, as appropriate, or be part of an approved health screening programme.
Since referring medical practitioners usually have the most complete picture of the patient’s health, they should be responsible for the guidance of the patient in undergoing only necessary procedures and benefitting from them. Particularly, this responsibility weighs more on generalists such as primary care providers. In order to facilitate justification in the case of radiological procedures, it is desirable that referring medical practitioners are knowledgeable about radiation effects in regard to the various dose ranges. The referring medical practitioners are responsible for keeping their knowledge about radiation up to date. In support of this, they should be provided education in radiation protection during their medical studies.
According to the BSS, the justification of medical exposure for an individual patient shall be carried out through consultation between the radiological medical practitioner and the referring medical practitioner, as appropriate, with account taken, in particular for patients who are pregnant or breast-feeding or paediatric, of:
Justification should be patient specific. The referring medical practitioner should take into account all clinical aspects regarding the management of every patient separately. Other possible procedures with lower or no exposure, such as ultrasound or magnetic resonance imaging, should be considered, if and when appropriate, before proceeding to radiological procedures.
According to the BSS, in order for a symptomatic or asymptomatic patient to undergo a medical procedure that involves ionizing radiation, the patient or the patient’s legally authorized representative should be informed in a timely and clear fashion, of the expected diagnostic or therapeutic benefits of the radiological procedure as well as the radiation risks. Thus, the emphasis is on provision of information.
According to the guidelines published by the Royal College of Radiologists (RCR), a useful investigation is one in which the result, either positive or negative, will alter a patient’s management or add confidence to the clinician’s diagnosis. According to the RCR guidelines, there are some reasons that lead to wasteful use of radiation. With emphasis on avoiding unjustified irradiation of patients, the RCR report has provided a check list for physicians referring patients for diagnostic radiological procedures:
There are various reasons that may lead medical practitioners to refer patients for more procedures than needed. Practitioners should be aware of that and take action to avoid such situations. Some of the reasons that lead to over-investigation are the following:
During the last 20 years international and national organizations published guidelines for proper justification of radiological procedures. The UK Royal College of Radiologists (RCR) publication "Making the best use of clinical radiology services " has been in print since 1989. The American College of Radiology (ACR) published its guidelines as Appropriateness Criteria. Similar efforts have been undertaken by the Department of Health of Western Australia in Diagnostic Imaging Pathways.
For references of publications from national societies in Europe, Oceania, and other regions please see publication from Remedios. These publications constitute guidelines and aim to guide referring medical practitioners in the selection of the optimum procedure for a certain clinical problem. In case there are alternative procedures that do not utilize radiation but yield results of similar clinical value, these guidelines encourage the avoidance of radiological procedures.
The cited publications deliver very specific guidance to help practitioners perform justification properly.
A medical physicist with experience and expertise in radiation protection will be able to provide information and guidance on radiation doses and risks in radiological procedures. In case you do not have an access to the help of radiation protection experts, referring medical practitioners may address their questions to their colleagues who work in radiology departments. However, staff specialized in radiation protection is more likely to provide complete, responsible and up-to-date information for the specific clinical problem. Radiation protection experts are comfortable with dose measurements and quantities which come from the domain of natural sciences and are usually hard to conceive for people outside the field.
The referring medical practitioner should be aware about procedures which impart high radiation dose to patients in order to be more cautious in such cases. This does not mean that other procedures should be written without proper justification. A quantitative knowledge of doses of various procedures is useful for the referring medical practitioner. Data given below will help the practitioner in that direction. In diagnostic radiological procedures, dose depends on the modality used. Computed tomography (CT) exposes patients to relatively high doses in comparison to other diagnostic imaging modalities.
Interventional diagnostic and therapeutic procedures that utilize fluoroscopy may also be a source of high radiation doses. Such procedures carry the risk of causing erythema to patients that receive high dose in single or repeated procedures. Some nuclear medicine procedures are also responsible for high radiation doses to patients.
The responsibility to identify patients that might be pregnant and are unaware of it is shared by the patient, referring medical practitioner and the imaging service providers. Safeguards to avoid inadvertent exposures of the foetus should be observed at all times.
The “ten day rule” was postulated by ICRP for women of reproductive age. The more latest “28-day rule” allows radiological procedures throughout the complete menstrual cycle unless there is a missed period. When a woman has a missed period, she is considered pregnant unless proven otherwise.
Even if safeguards are observed, sometimes a pregnant patient may be exposed to radiation. Depending on the radiation dose and the gestation age of the foetus, radiation effects may differ. Radiation risks are most significant during organogenesis in the early foetal period, somewhat less in the second trimester, and least in the third trimester.
As a rule of thumb one can assume that properly carried out diagnostic radiological procedures to any part of the body other than the pelvic region or when the primary X-ray beam is not passing through the foetus can be performed throughout pregnancy without significant foetal risk, if clinically necessary and justified. For radiological procedures where the primary beam intercepts the foetus, advice from the medical physicist should be obtained, who will calculate radiation dose to the foetus and, based on that, the practitioner and patient should make a decision. However, doses associated with radiotherapy procedures and interventional procedures are high and they require the attention of experts (including medical or health physicists, practitioners, and sometimes engineers and epidemiologists). In the case when a practitioner is responsible for a patient who has undergone a radiological procedure inadvertently and has subsequently been found to be pregnant, advice from the individuals listed above is needed. For more information, please click here where comprehensive information is provided not only for diagnostic radiology but also for nuclear medicine and radiotherapy.
Sometimes it is imperative that pregnant women should undergo radiological procedures. The referring medical practitioner and the imaging provider have to be mindful of risk and benefit and decide whether a radiological procedure should be asked for or if the medical problem may be solved by other non-radiological procedures. Generally, it is preferable that non-radiological procedures, or at least those that do not provide exposure to ionizing radiation, are used whenever possible. However, the use of radiological procedures is not prohibited and, when properly justified, they may be optimized so that these procedures may help to achieve the desired result for the patient while keeping dose to the foetus at low levels. The patient should be made aware about the possible impact of radiation exposure to the foetus. The need for consent must be determined based on individual practice standards, guided by more global professional or regulatory/legislative requirements.
Acute injuries such as skin erythema, blistering and hair loss have been recognized as a rare side effect of procedures guided by fluoroscopy. Similar injuries have been long recognized in radiation oncology, which uses much higher doses of radiation than diagnostic imaging. While radiation therapy is administered in fractions and the radiation-inflicted cells may recover in between sessions, fluoroscopy usually imparts a high dose to the skin in a short amount of time and with no dose fractionation. Referring medical practitioners could miss recognizing acute radiation injury resulting from interventional procedures. Such injuries may appear weeks after the interventional procedure and patients may not think of the procedure as being the cause unless they have been instructed accordingly by the interventional facility. Practitioners have often tended to attribute injury to many other causes, including insect bite and allergic reactions, but not to radiation exposure. Awareness about radiation through fluoroscopy being a possible cause can avoid mis-diagnosis and patient suffering.
In continuation of the Center's tradition of pioneering programs, SLU LAW holds an annual Health Law Practitioner-in-Residence Program. A visiting health law attorney is hosted by the Center for one to three months at the School of Law.
The attorney has the opportunity to reflect on the practice of law and refresh his or her perspective while offering students and faculty insight into the realities of the practice of health law.
In past years, the practitioner has assumed numerous roles, including taking time to write articles, serving as a guest lecturer in health law classes, presenting timely issues to local health law attorneys, holding student roundtables, and meeting with health law faculty to discuss issues relevant to both academia and practice.